Nephropathy progression in hypertensive Type 2 diabetes common
MedWire News: The risk for progression of nephropathy among patients with Type 2 diabetes and hypertension may be higher than previously believed, research suggests.
Nearly half of the patients in the population-based study who had normoalbuminurea at baseline developed micro- or macroalbuminurea an average of just over 5 years later.
The US researchers say: "Our results suggest that the lifetime risk of nephropathy among patients with Type 2 diabetes may be greater than previously reported."
Progression through stages of nephropathy has not been well described in a large, well-characterized, population-based study, say Suma Vupputuri (Kaiser Permanente Georgia, Atlanta) and colleagues.
To rectify the situation, they identified 10,290 members of a managed care organization who had hypertension and Type 2 diabetes and had urine albumin-to-creatinine ratio (UACR) measured in 2001-2003, and again on at least two other occasions 3 to 5 years later.
Overall, 57% of patients had normoalbuminuria (<3.4 mg/mmol), 31% had microalbuminuria (3.4-3.8 mg/mmol), and 12% had macroalbuminuria (at least 33.9 mg/mmol) at baseline.
During a mean follow-up of 5.4 years, 40% of those with normoalbuminurea progressed to microalbuminurea, 6.3% progressed to macroalbuminurea, and 0.08% to end-stage renal disease.
The incidence of nephropathy progression was 94.7, 35.1, and 6.5 per 1000 person-years for normo-, micro-, and macro-albuminuria, respectively.
The authors note, in the journal Diabetic Research and Clinical Practice, that the use of ACE inhibitors and angiotensin receptor blockers was lower than expected, ranging from 61% to 67%, except among patients with macroalbuminuria at follow-up.
Age, diabetes duration, and glycated hemoglobin levels were significant predictors of progression.
The researchers conclude: "Our study suggests that developing successful strategies to prevent or slow the progression of nephropathy are needed as these may effectively reduce the burden of disease."
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By Anita Wilkinson